Maderbacher Günther, Keshmiri Armin, Zeman Florian, Grifka Joachim, Baier Clemens
Department of Orthopaedic Surgery, University of Regensburg, Regensburg, Germany.
Center of Clinical Studies, University of Regensburg, Regensburg, Germany.
Knee Surg Sports Traumatol Arthrosc. 2015 Nov;23(11):3244-50. doi: 10.1007/s00167-014-3157-4. Epub 2014 Jul 5.
Reconstructing the natural joint line in knee revision surgery improves clinical and functional outcome but may be challenging when both cartilage and bone were removed during previous operations. Assessing joint lines (JLs) by means of bony landmarks is inadvisable because of large variations in human anatomy. Because of the inherent symmetry of the human body, we hypothesised that JLs may be directly assessed by measuring the distances from the bony landmarks to the JL of the contralateral knee by means of radiographic images.
Using scaled weight-bearing radiographs in anteroposterior view of both knees, two independent observers measured the distances from the fibular head, the medial and lateral epicondyle, and the adductor tubercle to the JL. A two-sided p value of ≤0.05 was considered statistically significant.
Two hundred knees of 100 patients (50 men and 50 women) were examined. For the fibular head, the mean difference between the treated and the control knee was 0.0 mm with narrow confidence limits ranging from -1.1 to 1.1.
As a new assessment method, we have suggested to assess the JL by means of radiographs of the contralateral knee. The most precise parameter was found to be the distance between the fibular head and the JL. The level of arthritis, age, gender, visibility of the landmarks, and misalignment did not influence measurement accuracy. This parameter is the first tibia-related landmark for assessing the JL, which advantageously corresponds to the tibia-first technique in revision surgery.
Diagnostic Study, Level II.
在膝关节翻修手术中重建自然关节线可改善临床和功能结果，但在前次手术中软骨和骨均被切除时可能具有挑战性。由于人体解剖结构差异较大，通过骨性标志评估关节线并不可取。鉴于人体固有的对称性，我们推测可通过影像学图像测量骨性标志到对侧膝关节关节线的距离来直接评估关节线。
使用双膝前后位的缩放负重X线片，两名独立观察者测量从腓骨头、内外侧髁以及内收肌结节到关节线的距离。双侧p值≤0.05被认为具有统计学意义。
检查了100例患者（50例男性和50例女性）的200个膝关节。对于腓骨头，患侧膝关节与对照膝关节之间的平均差异为0.0mm，置信区间狭窄，范围为-1.1至1.1。
作为一种新的评估方法，我们建议通过对侧膝关节的X线片来评估关节线。发现最精确的参数是腓骨头与关节线之间的距离。关节炎程度、年龄、性别、标志的可见性和对线不良均不影响测量准确性。该参数是评估关节线的首个与胫骨相关的标志，这在翻修手术中有利地对应于胫骨优先技术。
诊断性研究，二级。
